Plastics

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General Information

When consulting PT or OT, therapists must know the following information before an evaluation or treatment will be completed. If this information is absent, they will page you for clarification and will not see your patient until this information is obtained.
For information regarding weight-bearing statuses and activity order options, refer to chart below.
If there are no restrictions for a particular category, simply delete that item (you do not have to write “no restrictions”, therapists will assume that is the case if not mentioned).
Once completed, copy and paste this information into a nursing communication “Activity Order” in Epic.
If a splint is required for your patient, enter a separate nursing communication order to specify type of splint requested and additional details (see Splint information below).
Included on this page are the restrictions of the most common plastic surgery operations, as well as an inclusive list of all information that may be required.

Weight-bearing statuses

Range of Motion: [enter extremity(ies), digits affected; degrees of motion allowed for each digit in each plane]
Weight-bearing: [enter extremity(ies) affected, weight-bearing status of specified extremity(ies)]
Elevation and Dangle: If continuous elevation required, state here. If dangle allowed (limb in gravity-dependent position), state [duration of time dangle allowed + number of times per day]
Venous Flow Coupler and/or Vioptix: [enter amount of time coupler may be disconnected] [enter acceptable Vioptix parameters]
Additional Restrictions: [enter lifting restrictions (in pounds), gross activity restrictions e.g. no pulling here]
Post-operative activity pathway: [please use Activity Status chart to select level of activity in which pt may participate on which POD]. Example = POD 0: Bedrest; POD 1: Out of bed to chair; POD 2: Activity as tolerated
Walker use allowed: Yes or No

Range of Motion: Bilateral shoulder ROM no greater than 45 degrees in all planes, hips to remain flexed to at least 30 degrees at all times
Weight-bearing: BUE NWB
Venous Flow Coupler: may be disconnected for no more than 10 minutes at a time
Walker use allowed: Yes, may rest hands gently on walker
Additional Restrictions: No lifting greater than 5lbs, no pushing, no pulling
Post-operative activity pathway = POD 0: Bedrest; POD 1: Out of bed to chair; POD 2: Activity as tolerated

At post op visit <10 lb weight limit for 1 month. No pushing or pulling. Limit ROM of shoulders to 45 degrees in all directions.
After 1 month: passive ROM of arms. Relax weight limits. by 6 weeks back to normal activity.

Weight-bearing: NWB to (specify extremity(ies) restricted)
Additional restrictions: Use pillow under (specify RUE, LUE, BUE) while in bed to prevent pressure on flap. Use sling at all other times. Patient may have arm at side with sling in place for out of bed activities including ambulation.

Weight-bearing: BLE WBAT
Walker use allowed: Yes, if needed
Additional Restrictions: Must ambulate with with legs shoulder-width apart (no thigh to thigh contact), abduction pillow while in bed, no active abduction of surgical (involved) extremity, keep surgical sites dry.
Post-operative activity pathway = POD 0: Bedrest; POD 1: Activity as tolerated

Pain/perfusion catheter d/c POD#4 or #5 (5 days max per APS)

Dangles (limb in gravity-dependent position): Begin on day 2, unless in frame - further information pending
Additional Restrictions: pending
Splint: Posterior splint required if no frame.
Post-operative activity pathway: pending

Weight-bearing: NWB to [involved extremity(ies)
Elevation and Dangles (limb in gravity-dependent position): Keep (involved extremity(ies) elevated at all times POD 0-5. May begin dangles POD 6 for 5 minutes TID, increasing by 5 minutes per dangle daily as approved by plastic surgery team.
Splint: If no frame present, posterior splint required.
Post-operative activity pathway: POD 0-3: Bedrest, POD 4-5: out of bed to chair and commode with (involved extremity) elevated at all times, POD 6: Begin dangle protocol per above.

If a patient requires a splint, an order set exists in Epic that will prompt you to enter necessary information needed by PT/OT before a splint can be fabricated. These can often be complex, so usually at least one, brief phone call will be required, however, this will at least give PT/OT helpful initial info.
For upper extremity splints:
- In Epic, go to patient's chart > Manage Orders > in search bar enter “UPPER EXTREMITY SPLINT FABRICATION/PROVISION > fill out additional information > sign.
For lower extremity splints:
- In Epic, go to patient's chart > Manage Orders > in search bar enter “LOWER EXTREMITY SPLINT FABRICATION/PROVISION > fill out additional information > sign.